AB0900 NINTEDANIB DOES NOT IMPROVE NAILFOLD CAPILLARY ABNORMALITIES IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: T. Sugimoto, H. Watanabe, Y. Yoshida, S. Mokuda, S. Hirata
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The pathogenesis of SSc consists of three aspects: fibrosis, angiopathy, and immune abnormalities. Nintedanib has been shown to be effective against interstitial lung disease (ILD) as an antifibrotic drug, but it may also have effects on vascular disorders due to its inhibitory effects on FGF, PDGF, and VEGF. While nailfold capillary abnormalities in patients with systemic sclerosis (SSc) may improve with immunosuppressive therapy, no reports have evaluated whether nintedanib improves nailfold capillary abnormalities. <h3>Objectives</h3> To clarify whether nintedanib improves nailfold capillary abnormalities in patients with SSc complicated by ILD. <h3>Methods</h3> This study is a prospective observational study. Among patients diagnosed as having SSc according to the 2013 ACR/EULAR classification criteria, those who started to treat with nintedanib for ILD at our hospital from March 2020 to July 2022 were consecutively registered. The nailfold capillaries were evaluated using a nailfold videocapillaroscopy (NVC), capable of observation at 200x magnification. The evaluation was carried out using the current standardized method.[1]NVC was performed before drug induction and 1 year after drug induction. Only patients who had NVC testing up to 1 year later were included in the evaluation. At the same time, blood tests such as KL-6, SP-A, and SP-D, and respiratory function tests were evaluated. This study has been pre-approved by the Hiroshima University Hospital Ethics Committee. (OySTeR study: Optimal strategy in SSc Treatment for Recovery, approval number: E-1940-1) <h3>Results</h3> Eight patients were analyzed. The mean age was 59 ± 17 years. Female were 7 (87.5%). Six patients (75%) were positive for anti-Scl-70 antibodies. Details of other cases are listed in Table 1. Seven patients (87.5%) had a history of treatment with immunosuppressive therapies. The disease duration was less than 6 years in 5 patients, and 6 years or longer in the remaining 3. Five patients were able to continue nintedanib for 52 weeks: 1 patient discontinued nintedanib after 1 month due to abnormal liver function, 1 patient with diarrhea discontinued after 10 months. All of the patients who were able to continue oral administration were also reduced to 200 mg/day due to diarrhea. Baseline mean FVC, KL-6, SP-A, and SP-D are described in Table 1. The results by NVC pattern were Normal in 1 case, Early in 2 cases, Active in 1 case, Late in 3 cases, and Non-specific in 1 case. Quantitative baseline results for the NVC tests were capillary density (number of capillaries) 5.8 ± 2.2/mm, enlarged capillary score 0.91 ± 0.83, giant capillary score 0.31 ± 0.30, and hemorrhage score 0.22 ± 0.27. 1 year later, the NVC pattern deteriorated from early to active in only one case, but the others remained unchanged. Quantitative results for the NVC test were capillary density 5.8 ± 2.3/mm, enlarged capillary score 0.98 ± 0.95, giant capillary score 0.38 ± 0.48, and hemorrhage score 0.20 ± 0.33. Mean FVC, KL-6, SP-A, and SP-D after 1 year are also shown in Table 1. <h3>Conclusion</h3> Nintedanib tended to improve ILD biomarkers and pulmonary function test results in patients with SSc, but did not improve nailfold capillary abnormalities. Based on this result, combination therapy is preferable to nintedanib alone for improving the pathology of SSc. <h3>Reference</h3> [1]Smith V, Herrick AL, Ingegnoli F, Damjanov N, Angelis R, Denton CP et al. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev. 2020;19(3):102458. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Tomohiro Sugimoto Speakers bureau: Boehringer Ingelheim, Kyowa Kirin Co, Mitsubisgi Tanabe Pharma, Asahi Kasei Corporation, Astellas Pharma, AYUMI Pharmaceutical Corporation, Bristol-Myers Squibb Company, Janssen Pharmaceutical K.K., UCB., Paid instructor for: Astellas Pharma, Asahi Kasei Corporation, Eisai Co., Hirofumi Watanabe Speakers bureau: Tanabe Mitsubishi, Yusuke Yoshida Speakers bureau: Astellas, Bristol-Myers Squibb, Chugai, AstraZeneca, Paid instructor for: Tanabe Mitsubishi, Bristol-Myers Squibb, Chugai, Eisai, Sho Mokuda Speakers bureau: Ily Lilly, Asahi-Kasei, Astellas, Eisai, AbbVie, UCB, Tanabe-Mitsubishi, Taisho Pharmaceutical Co., AstraZeneca, Shintaro Hirata Speakers bureau: AbbVie, Asahi-Kasei, Astellas, Ayumi, Bristol Myers Squibb, Celgene, Chugai, Eisai, Gilead, Glaxo Smithkline, Ily Lilly, Janssen, Kyorin, Novartis, Pfizer, Sanofi, Tanabe-Mitsubishi, UCB, Paid instructor for: AbbVie, Tanabe-Mitsubishi, Consultant of: AbbVie, Astellas, Bristol Myers Squibb, Eisai, Gilead, Eli Lilly, Grant/research support from: AbbVie, Asahi-Kasei, Eisai, Otsuka, Sanofi, Shionogi, Chugai, Pfizer, Tanabe-Mitsubishi, Ily Lilly, UCB.